Physical rehabilitation and activation tools in post-stroke rehabilitation period

Фотографии: 

PhD, Associate Professor J.E. Firileva
Herzen State Pedagogical University of Russia, St. Petersburg

Keywords: motor activity, cerebral stroke, pedagogical control, acute, rehabilitation and adaptation periods.

Introduction. Motor activity is understood as a type of human life activity that activates all the metabolic processes in the bodily organs and systems and thus maintains the work of the musculoskeletal system and ensures spatial movements of the body and body parts. It is a total quantity of various movements over a particular period of time [3].

It should be noted that motor activity implies special physical exercises, including those aimed to restore the movement abilities lost after a cerebral stroke or other musculoskeletal injuries. Motor activity is an integral part of the post-stroke rehabilitation process.

Objective of the study was to determine the effects of physical rehabilitation and activation tools aimed to cure the movement patterns in post-stroke patients.

Methods and structure of the study. The study of the post-stroke physical rehabilitation and activation tools was performed in six health clinics in Saint Petersburg and Leningrad region in the period of 2014 to 2017, with 248 patients sampled for the study.

The basic movement parameters were analyzed: affected upper and lower limbs, sitting and standing postures, walking, physical (motor) qualities, everyday activities.

The post-stroke physical activation tools include special physical exercises from different gymnastics disciplines: remedial gymnastics [5, 7, 8]; segmental gymnastics [7, 8]; exercises to relax tight muscles and breathing exercises [3, 5, 7, 8]; adaptive gymnastics [2, 7, 8]; fine motor skills building exercises [6, 7]; articular gymnastics [4, 7, 8]; balance exercises and exercises to develop vestibular reaction stability [1, 2].

The post-stroke rehabilitation periods are classified according to the movement pattern recovery areas.

The acute period is determined by the time of hospitalization that lasts three weeks (21 days) or longer.

The first rehabilitation period is the most effective, and its terms are fixed - up to 6 months.

The second period, so to speak, completes the rehabilitation processes, and it lasts up to 1 year since the disease appeared.

The adaptation period is characterized by the consolidation and improvement of the rehabilitation processes and lasts up to 2 years since the disease appeared, or longer.

Each motor function was evaluated using a specially developed control test that made it possible to rate the rehabilitation progress on a 5-point scale, which is a good physical rehabilitation quality criterion [8].

Results and discussion. During the acute rehabilitation period, the post-stroke patient performs passive movements only with the help of a physical therapist and only after a consulting physician’s approval. The patient's motor activity is lowermost. He cannot move the affected leg or arm without the help of another person. He starts to sit only at the end of this period - and that only because he leans back against the raised side of a bed. He barely stands, holding the support with both hands, trying to walk in a high walker being assisted by the physical therapist. Early attempts to walk may result in the negative stepping skill formation.

It is impossible to analyze the post-stroke patients’ motor (physical) qualities in the acute period of rehabilitation. In terms of everyday activities, changes are statistically insignificant in this rehabilitation period.

The first post-stroke rehabilitation period is characterized by some improvements in the movement parameters. That is where passive and passive-active movements are applied for the affected movement patterns. Yet, it is an assistance-required period when the patient needs help from health personnel and supervisors.

It can be said that the upper limb movements were rated by 1.30 points, those of the lower limb – by 2.71 points, walking - by 2.57 points. And only the sitting and standing postures after a 6-month rehabilitation were rated positively: by 4.09 and 4.00 points, respectively.

In the first period of physical rehabilitation low indicators are typical. Thus, the arm muscle strength is still at the level of 0-1 points. The leg muscle strength indicators reflect the patients’ capabilities only when they get off their bed or chair for the 1st-2nd time, with support on both arms.

Flexibility characterizes lumbar-spine mobility when leaning forward, and is rated by 1 point in this period. Movement coordination is observed only when the body is held in a vertical position leaning on a bed or back of a chair with both arms. There are no manifestations of the balance function, since the patient cannot perform the test task. The endurance indicators are not expressed in any way, as the patient cannot walk.

We found the quality of everyday activities (movements) to enhance by the first rehabilitation period. Thus, most patients can move from a bed to a chair and back on their own. They perform some hygienic measures on their own, too.

The second period (up to 1 year) is marked as critical. This period is the most favorable for the recovery of the affected movement patterns in post-stroke patients. That is where mainly active movements are applied corrected by the physical therapist or other assistants. The second rehabilitation period was characterized by more significant test results, and all the indicators had significant differences as opposed to the first rehabilitation period: p<0.01 (see Table 1).

Table 1. Results of recovery of movement patterns in post-stroke patients during residential treatment, disorders estimated on a 5-point scale of control test (n=23)

Rehabilitation period

Movement pattern recovery areas

Upper limb

Lower limb

Sitting posture

Standing posture

Walking

After the 1st period

(up to 6 months)

1.30

σ = 0.79

m = 0.17

2.71

σ = 0.79

m = 0.17

4.09

σ = 0.52

m = 0.11

4.00

σ = 0.52

m = 0.11

2.57

σ = 0.79

m = 0.17

After the 2nd period

(up to 1 year)

2.38

σ = 0.95

m = 0.20

3.52

σ = 1.32

m = 0.29

4.76

σ = 0.52

m = 0.11

4.28

σ = 0.26

m = 0.05

3.42

σ = 0.79

m = 0.17

Significance of differences, р

p< 0.01

P< 0.01

P< 0.01

p< 0.05

p< 0.01

After the adaptation period

(1-2 years)

3.03

σ = 0.66

m = 0.14

4.21

σ = 0.16

m = 0.03

4.95

σ = 0.26

m = 0.05

4.85

σ = 0.26

m = 0.05

4.21

σ = 0.52

m = 0.11

Significance of differences, р

< 0.01

< 0.05

< 0.05

< 0.05

< 0.01

During the second period, the physical rehabilitation indices improved significantly. The patients were able to perform the test tasks better: the arm muscle strength was rated by 2 points; the leg muscle strength – by 3 points; flexibility – by 3 points; movement coordination in most cases was rated as unsatisfactory; the balance function was rated by 1 point; endurance indices were still low.

By the second rehabilitation period, the range of the patients’ everyday activities expands. They can dress themselves, eat and cook, do washing-up, perform all hygienic measures themselves.

The adaptation period is characterized by a significant improvement of the motor function, and all the studied parameters are steadily rated by 5 points or close to that, except for the arm movements. As is known, it takes longer to restore the movements of the affected upper limb. At the same time, the upper and lower limb movements and walking significantly improve as opposed to the previous stage of rehabilitation (p<0.05-0.01; see Table 1).

The adaptation period is characterized by the improvement of physical qualities in response to consistent execution of the test tasks. The arm muscle strength improved compared to the previous rehabilitation period - 4 points. The leg muscle strength was at the good level, 3-4 points. Flexibility improved up to 4 points. Movement coordination, balance function and endurance increased up to 2 points.

Regarding everyday activities, almost all the post-stroke patients can take care of themselves at home during the adaptation period.

Conclusions:

  •    We observed the dynamics of recovery of the affected movement patterns in the post-stroke patients (upper and lower limb movements, sitting postures, standing postures, walking).
  •    The study revealed the possible increase in the level of physical qualities of the post-stroke patients only in the rehabilitation and adaptation periods.
  •    The quality of everyday activities (movements) improved during the first rehabilitation period. Most patients can take care of themselves at home during the adaptation period.
  •    The post-stroke physical rehabilitation and activation model was found beneficial for recovery of the movement patterns.

References

  1. Galkin A.S. Puti povysheniya reabilitatsionnykh meropriyatiy u bolnykh, perenesshikh ishemicheskiy insult. Avtoref. dis. kand. med. nauk [Ways to increase rehabilitation measures for patients after stroke. PhD diss. abstract]. 2015, 27 p.
  2. Kovalchuk V.V. Reabilitatsiya patsientov, perenesshikh insult [Post-stroke rehabilitation]. Moscow, 2016, 328 p.
  3. Milyukova I.V., Evdokimova T.A. Lechebnaya fizkultura: teoriya i metodika [Exercise therapy: theory and practice]. Rostov-on-Don, 2002.
  4. Norbekov M., Khvan Yu. Uroki Norbekova. Doroga v molodost i zdorovye [Norbekov's lessons. The way to youth and health]. St. Petersburg: Piter publ., 1999, 192 p.
  5. Robenesku N. Neyromotornoe perevospitanie [Neuromotor reeducation]. Transl fr. Rum. Dr. S. Duvan. Bucharest: Medical publ., 1978, 268 p.
  6. Filippova S.O. Podgotovka doshkolnikov k obucheniyu pismu. Vliyanie spetsialnykh fizicheskikh uprazhneniy na effektivnost formirovaniya graficheskikh navykov [Preparing preschoolers for learning writing. Effect of special physical exercises on efficiency of graphic skills building]. St. Petersburg: Detstvo-Press publ., 2004, 94 p.
  7. Firileva J.E. Pedagogicheskie aspekty neyromotornoy reabilitatsii lits, perenesshikh insult [Educational aspects of post-stroke neuromotor rehabilitation]. Moscow: RANH publ., 2015, 152p.
  8. Firileva J.E., Zagryadskaya O.V. Pedagogicheskie tekhnologii domashney reabilitatsii pri insulte [Educational technologies of home post-stroke rehabilitation]. Moscow: RANH publ., 2017, 242p.

Corresponding author: firilevaze@yandex.ru

Abstract

The study analyses the physical rehabilitation and activation tools applicable in the post-stroke rehabilitation period to cure the movement patterns in the patients. The physical activation tools include special physical exercises from different gymnastics disciplines with health and corrective focus. We applied a 5-point rating scale to rate the rehabilitation progress in the upper and lower limbs, sitting and standing postures, walking skills, a variety of physical qualities and practical skills. The study found that the post-stroke activity is lowermost in the primary (acute) rehabilitation period followed by an assistance-required period when the patient is helped by a physical therapist, health personnel and family.

In the first 6 post-stroke months, the motor progress is normally limited followed by the second period (up to 1 year) most favourable for further progress in every aspect, with increased self-reliant activity recommended to the patients. In the next adaptation period (up to 2 years and more), the motor activity and movement stability tend to further grow up to the possible best level rated by 5 points. The post-stroke physical rehabilitation and activation model was found beneficial for recovery of the movement patterns.